Order Form

Send to: Long Acre Plants, Charlton Musgrove, Somerset, BA9 8EX

Name:
Address:
 
 
Postcode:
Telephone:
No.

Plant Name

£

p
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
       
Total    
P & P    
Grand Total    

Payment by Maestro, Visa or MasterCard.

Card Number.                                                        Expiry Date.
Name on Card.                                                       Signature.
Maestro or Switch card issue number.                     Security Number.

For Office use:           Received-                                    Order Sent-                         

Special Delivery Instructions.

Further additions or if you want to list any substitutes

No.

Plant Name

£

p